WRIST-OA?

[ALTSELGREEN]

Have been having pain and swelling in my wrist for a couple of months-steadily getting worse. Broke this wrist 13 years ago so I assume that could have something to do with it.
My GP ordered an X-ray which shows some degenerative issues. He has said it is Arthritis and has referred me to a specialist for further investigation. Does anyone have any similar experience and the obvious implications?:hmm:

[gingernut]

There are a couple of issues here ALT.

Firstly, is the pain and swelling related to some underlying inflammatory condition (eg Rh Arthritis etc), or is a "mechanical" issue (ie wear and tear.)?

With the usual caution of this is the internet, (back up anything by talking to your doc), the history you have given suggests a mechanical cause.

Good news in a way, but treatments are probably fairly limited. (Pain relief, physio, maybe an injection??)

If you're a pilot, functionality is probably the main issue. Remember to tell your doc that you are a pilot, before he makes any prescribing decisions.

[ALTSELGREEN]

Hello Ginge

Thanks for the reply- definitely a 'wear and tear' issue. Becomes more painful with excessive use and is always swollen to some degree. Not really sure what the specialist will suggest, but I think the initial plan is to get an MRI. Will of course explain the job angle as well.

[Ulster]

Remember to tell your doc that you are a pilot, before he makes any prescribing decisions

Gingernut is absolutely right on that point, which it's worthwhile to emphasize. Reference has been made on another thread here very recently indeed, about the use of very new anti-rheumatic medication in AS. The CAA will take a very cautious view of anything which has not been proven by regular usage over a period of time.

On the other hand, simple analgesics and NSAID's ( eg paracetamol, ibuprofen, and similar ) will usually cause no problems in flight crew personnel. :D

[ALTSELGREEN]

Update- have had to go back to GP as wrist quite painful and ibuprofen/paracetamol not doing too well. He is now of the opinion that it may be imflammatory arthritis rather than OA. Seeing specialist Thursday:uhoh:

[Ulster]

He is now of the opinion that it may be inflammatory arthritis rather than OA

That's unfortunate ; OA symptoms usually a bit less, and a bit easier to alleviate. Hoping the consultant visit goes well ( how do you manage to get seen so quickly ? ? ! ).

To reiterate the advice above : if the specialist suggests any medication, particularly any of the relatively recently introduced ones, it's a good idea to discuss with your AME (or the CAA med dept) before starting to take them.

Good luck ! :ok:

[gingernut]

ALT's, are you a pilot ?

[Ulster]

Must admit that I simply presumed so, after reading
Will of course explain the job angle as well :=

[ALTSELGREEN]

Yes I fly for an airline - my GP is also an AME ( although not my regular examiner).

[ALTSELGREEN]

Good news really. Not inflammatory Arthritis. Had some more comprehensive X-rays and they have shown that I have early signs of Osteoarthritis around the scaphoid. Apparently a common place for this to start in males of a certain age?
Prescribed Diclofenac for the pain and swelling, so hope to see results soon. Is long term use of this medication feasable? I am hoping that the inflammation will reduce enough to use just ibuprofen and paracetamol.

[Ulster]

Prescribed Diclofenac for the pain and swelling, so hope to see results soon. Is long term use of this medication feasible?

The answer to that is "yes". As you say, aim should be to reduce to something milder as time goes on. Diclofenac is one of the stronger members of the family generically known as NSAID's.

Glad to hear it was nothing any more sinister ! :ok:

[gingernut]

Great news.

In terms of flying (back it up by the AME blah blah), retaining functionality is of utmost importance.

As we get older, we've all got some degree of OA. It's a bit like getting grey hair.

Pain relief is important, have a look at the WHO pain ladder for further guidance, but be aware that some of the "adjuncts" probably aren't compatible with flying. I guess codeine based stuff should be best avoided if possible.

Regular paracetamol is bottom of the ladder, underrated, but often very effective.

Diclofenac is usually very effective. It's an "NSAID" and guess what? - they have their own "ladder." Diclofenac is mid way up the ladder, ibuprofen is bottom of the ladder. Naproxen is somewhere inbetween. I prescribe, (and use!) a lot of it.

Long term use of nsaids is not always ideal, it has been associated with sudden death, gastric bleeding and kidney problems. It can also put your blood pressure up. The higher up the ladder, the higher the risk.

As always, it's a risk/benefit equation, and there's lots of other factors to consider-if required long term, chat to your prescriber.

[ALTSELGREEN]

Thanks to both of you for the good info and advice;)

[ALTSELGREEN]

6 months or so on - I have had an ultrasound guided cortisone injection which proved unsuccessful - So I am now just controlling symptoms with ibuprofen or Naproxen ( with omeprazole) if it flairs up- usually a result of over use. 😟

[Winnerhofer]

You need an RMI to check that the connective nerve has not been affected by your condition.
Have you had piroxicam shots?

[ALTSELGREEN]

No MRI, but a number of X-rays which confirm narrow spacing between certain wrist bones. Have a good range of movement-and pain is now generally well controlled. The cortisone injection between the narrowed bones was unsuccessful with total relief only lasting about a week-no connective tissue issues have been highlighted......

[gingernut]

Be careful about medicalising part of the natural ageing process.

[Winnerhofer]

Undergo an RMI because x-rays and ultrasounds can't detect if the connective nerve tissue is affected usually C4/C5/C6.

[ALTSELGREEN]

Just an update on this- After the failed cortisone injection, I have battled on with NSAID's to control the symptoms which have been generally tolerable. Physio has not helped much, so I recently visited a hand consultant for his opinion. He looked at the original year old X-rays and has spotted what seems to be a scapholunate tear-to be confirmed by MRI. He thinks that when I fractured the wrist 15 years ago, the treatment I received concentrated on the distal radius break and totally missed the ligament damage.

[ALTSELGREEN]

3t MRI came back showing the scapholunate ligament intact which is good. It did however show up a TFCC tear and considerable synovitis and associated inflammation. Have been prescribed etoricoxib and another cortisone injection is planned. Hopefully this will produce satisfactory results without having to resort to surgery.:rolleyes: